<!DOCTYPE html>
<html>

<head>
    <title>客户返档资料</title>
    <link rel="stylesheet" type="text/css" href="../../css/style.css">
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1">
</head>

<body class="body-self">
    <form action="" class="form pd-lr-16">
        <div class="mt-20">
            <div class="form-item flex" >
                <label for="phone">服务号码</label>
                <input type="text" id="phone" class="font-left flex-1" value="15201148547">
            </div>
            <div class="form-item flex" >
                <label for="name">姓名</label>
                <input type="text" id="name" class="font-left flex-1" value="王琦琦">
            </div>
            <div class="form-item flex" >
                <label for="gender">性别</label>
                <input type="text" id="gender" class="font-left flex-1" value="男">
            </div>
            <div class="form-item flex" >
                <label for="nation">民族</label>
                <input type="text" id="nation" class="font-left flex-1" value="汉">
            </div>
            <div class="form-item flex" >
                <label for="card">证件号码</label>
                <input type="text" id="card" class="font-left flex-1" value="210105199909097841">
            </div>
            <div class="form-item flex" >
                <label for="address">证件地址</label>
                <textarea id="address" class="font-left flex-1">辽宁省沈阳市于洪区芙蓉山路百花小区7-3 342</textarea>
            </div>
        </div>
        <div class="flex flex-hori mt-40 mb-40">
            <p class="protocal">请确认以上信息，并阅读服务协议，提交即同意<a class="theme-color">《服务协议》</a></p>
            <input type="submit" class="btn btn-large" value="提交">
        </div>
    </form>
</body>

</html>